Enhancing Human Performance in Resuscitation Part 1: Going With The “Flow”

Additional Human Performance Posts by Mike

Optimizing human performance has been of paramount importance to the military for some time. In addition to the military, it is consequential for professional athletes as well as martial artists and even individuals in the corporate world. Psychological and physical training have been found by many in these areas to be a worthwhile investment. As opposed to building training that relies on equipment and technology, building resilience and mental toughness provides long-­-term, sustainable benefits that are manifest in nearly every activity. In deed, a truism in the world of military special operations is that “humans are more important than hardware.” I would argue the same is true in medicine.

The ultimate goal is to be able to enter into a state of ideal engagement where one is “firing on all cylinders,” or as many say “in the zone.” It is achieving a level of performance where clarity of thought and precision of physical activity are at their zenith. In a word: FLOW.

Mihaly Csikszentmihalyi, Professor of Psychology and Management at Claremont Graduate University’s Drucker School of Management, describes this phenomenon in his book, Flow: The Psychology of Optimal Experience. Entering into this state not only enhances performance, but also imbues happiness, creativity, and unparalleled innovation.

This state is fundamentally based on the balance between skill and challenge. Acquiring a high level of both cognitive and technical skill is, without a doubt, requisite. But, for intelligent and highly trained physicians, associate providers, nurses, and paramedics the other very important aspect of achieving “flow” is control of one’s psychological and emotional state in order to modulate the perception of challenge or difficulty. This is where focusing on human factors and performance psychology comes in. Psychological skills and tools can be taught to temper arousal, provide positive affirmation of capability, and improve coping skills. In midst of an arduous resuscitation, perhaps we should aim to go with the “flow.”

Fiore & Salas. “Cognition, competition, and coordination: The ‘why’ and the ‘how’ of the relevance of the sports sciences to learning and performance in the military.” Mil Psychol 2008; 20(Suppl 1): S1–S9.

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Mike Lauria. Enhancing Human Performance in Resuscitation Part 1: Going With The “Flow”. EMCrit Blog. Published on December 20, 2014. Accessed on December 19th 2018. Available at [http://emcrit.org/emcrit/flow/ ].

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You draw out a great point. Unfortunately, I think so many providers especially in EMS would write this off as rubbish. I find that these type of philosophical thoughts are not common among many in EMS. It seems they lean more towards the tangible and raw concepts. I fondly liken EMS to the wild west of medicine.

I think that will change one day, but it could be a long way down the road. Ironically, EMS has the greatest sphere of influence on most SCA victims. Like many of the world’s problems, the solution lies in education. Hopefully we will see the bar continued to be raised.

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3 years ago

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Mike Lauria

Hey Andrew, Thanks for reading and commenting! I do agree that these philosophical thoughts are less common. I also agree that you need to connect concepts like this to very real, tangible techniques, actions, or procedures that will generate legitimate improvements that individuals can feel or see. First, this is only part one. This was sort of a general, very nebulous introduction to the concept. There is more to come and specifically how you can navigate the stress, chaos, and “fog of resuscitation” to generate flow both inside and outside of the hospital. After all, I can’t spoil the punch line before the EMCrit/Mt. Sinai EM/Critical Care conference next week! Second, I disagree that people in EMS would write it off as rubbish. Some do. There are always some in every crowd. However, many EMS providers have prior service in the military or fire service. They understand the importance of performance in life and death situations. Furthermore, when you take the concept, distill its essence, and present it in a way that hits home, they are very open. In fact, I have found that the prehospital providers (thus far) are more open than many in-hospital providers. I do agree, education… Read more »

I definitely agree that EMS tend to be more open to change than in-hospital providers. Our perspectives on how readily EMS absorb information could be cultural based. Several of the counties in our area are very rural and backwoods. That’s not to say they wouldn’t be open to change, but it often times takes a lot more coddling and hand-holding to lead them to connecting the dots.

It’s definitely a challenge, and the challenges are different all over the country. That’s why I love education for the same reason I love medicine…it’s a constantly evolving challenge.

Mike, in your experience, has it been tougher for you to achieve a flow state in the military setting, or in the civilian world? Whichever it is, any thoughts on why?

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3 years ago

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Mike Lauria

Hey Bill,

I think it was a little bit more difficult in the military. The added stress of hostile forces to factors such as environmental dangers, patient deterioration, etc. makes the challenge and stress somewhat more pronounced. Some of the stimuli (explosions, etc.) are more intense and it easier to get distracted and jarred out of a flow track. However, once you are operating with a solid team and you get “in the zone”, the sense of flow is more intense. But, in my opinion, the added stress of combat situations makes you all the better at controlling your physiology and hitting that performance sweet spot.

That said, I get just as much enjoyment out of being stuck in the back of an EC-135 with deteriorating patient when your and your teammate are wired tight, hit your stride, things just start to flow, and the resuscitation goes (at least relatively) smoothly.